Complete three quick steps — read and sign your waiver, share a brief health history, then choose your time. The whole process takes about 5 minutes.
↓ Scroll to read the full document before continuing
Chase Riner | Somatic Realignment Therapy | Los Angeles, CA
chaose2@gmail.com | (863) 521-5157
I understand that Chase Riner is a somatic practitioner and bodyworker with over 15 years of experience in integrative healing arts. I acknowledge that Chase Riner is NOT a licensed medical doctor, physical therapist, chiropractor, licensed massage therapist, or mental health professional. All services provided are offered as complementary wellness support only and are not intended to diagnose, treat, cure, or prevent any medical or psychological condition.
The services I may receive include, but are not limited to:
I agree to disclose fully and honestly any and all medical conditions, injuries, surgeries, medications, allergies, psychological diagnoses, or physical limitations that may affect my participation. I understand that withholding relevant health information may create unnecessary risk and that it is my sole responsibility to provide accurate and complete health information prior to each session.
I understand that it is my responsibility to:
I voluntarily consent to receive Integrative Bodywork services from Chase Riner. I have had the opportunity to ask questions and have them answered to my satisfaction. I understand the nature, scope, and limitations of the services to be provided.
I understand that sessions may involve:
I acknowledge that any form of bodywork, manual therapy, movement guidance, or energetic practice carries inherent risks, including but not limited to: temporary muscle soreness, bruising, or discomfort; dizziness, lightheadedness, or fatigue; temporary emotional intensification or release; reactivation or temporary worsening of prior physical conditions; and rare but possible injury from manual manipulation or assisted movement. I voluntarily assume all risks associated with my participation.
In consideration of receiving services from Chase Riner and Somatic Realignment Therapy, I — for myself and on behalf of my heirs, assigns, personal representatives, and next of kin — hereby release, waive, discharge, and covenant not to sue Chase Riner, Somatic Realignment Therapy, and their agents from any and all claims, demands, losses, liabilities, and causes of action arising out of or relating to services received, whether caused by negligence or otherwise, to the fullest extent permitted by applicable law.
I understand and agree that this work does not constitute medical diagnosis or treatment, psychotherapy, chiropractic care, or any other form of licensed healthcare. I will not use these services as a replacement for consultation with licensed professionals. If I am currently under medical or mental health care, I agree to notify Chase Riner and to maintain my relationship with those providers.
I understand that somatic bodywork can catalyze the release of stored emotional or energetic material. I may experience unexpected emotions, memories, or physical sensations during or after sessions. This is recognized as a natural part of the healing process. Chase Riner is not a licensed mental health professional; any somatic dialogue or spiritual guidance is offered as experiential wellness support, not therapy or counseling.
I agree to the following terms:
All personal and health information shared during sessions is treated as strictly confidential and will not be disclosed to third parties without my written consent, except where required by law (e.g., mandatory reporting obligations, court order, or imminent risk of harm). Session notes, if maintained, are stored securely and used only to support continuity of care.
No audio or video recording of sessions will occur without the express written consent of both parties. I retain the right to grant or withhold consent for any testimonials, case studies, or use of my experience in promotional material. If identifying information is included, separate written consent will be obtained.
In the event of a medical emergency during a session, I authorize Chase Riner to contact emergency medical services (911) on my behalf. I agree to provide current emergency contact information in the health history form.
By signing this agreement, I confirm that I am 18 years of age or older. Services for minors require the written consent of a parent or legal guardian, who must also sign this agreement on behalf of the minor.
This agreement shall be governed by and construed in accordance with the laws of the State of California. If any provision of this agreement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect. This agreement constitutes the entire understanding between the parties with respect to its subject matter and supersedes all prior agreements, written or oral.
By electronically signing below, I confirm that:
Please check anything that applies. This information is confidential and helps Chase work safely and effectively with your body.
Your informed consent has been recorded. You're being redirected to the booking calendar in 3 seconds.
A copy of your submission reference will be sent to the email you provided.
"The body knows the way. Trust it."